With abolition of English community health councils on the horizon, local authorities are preparing to take on the key role of scrutinising the delivery of local health services. But they are doing so with varying degrees of confidence.

The new arrangements call for social services authorities to set up overview and scrutiny committees to analyse the full range of local health services - from the quality of treatment in hospitals to the waiting time to see a GP. And with formal implementation only months away, confusion is widespread as to how the new system will work in practice come January.

The principle of inspection and accountability is at the heart of the government's health modernisation programme. While local authorities are quick to voice optimism about the long-term benefits of the new system, the vast majority are, by their own admission, on a steep learning curve when it comes to investigating the complex world of today's NHS. "One of the most frequently asked questions I get from councillors is: 'What is an NHS trust?'," says Nigel Grinsted, of health and social care consultancy Healthskills.

The power to oversee health represents an important extension of local authorities' scrutiny function, which - modelled on the system of select committees in parliament - was itself introduced only two years ago. Many authorities are stressing a need to train councillors and the Department of Health promises to ensure that there will be effective training and support, though details will not be available until later in the autumn.

Grinsted suggests that local authorities should consider setting up an induction programme and running a pilot health inquiry. For health scrutiny to succeed, he says, authorities should be making connections with local health services now. He is optimistic about the prospects - as long as partnership remains at the fore. "I do feel that between 10% and 20% of local authorities are not going to get it right because they're not forming the relationships or putting the time into induction," he says.

Durham county council recognises the challenge and wants funding from government to draft in a health expert. "One of the things we're finding difficult is having to make contacts with an organisation that is unfamiliar and changing all the time," says head of overview and scrutiny, Ian Mackenzie.

Partly because of this factor, Kieran Walshe, director of research at the Manchester Centre for Healthcare Management, expects the early days of the new system to show a mixed performance. But he believes authorities will soon embrace the challenge. "I think that, to begin with, councillors won't be particularly well informed and they'll struggle with NHS policy issues," he says. "But the dynamics of it are that when the local population is exercised about local health issues, councillors are going to respond."

Overview and scrutiny committees will have powers of consultation and inquiry far greater than any that community health councils have had, Walshe claims. In addition, their work will be backed by a democratic mandate.

The government's plans to abolish community health councils met hostile and dogged resistance. To soften the blow, health councils will exist alongside scrutiny committees for a three-month transition period next year. Under the new system, overview and scrutiny committees will be expected to work in tandem with a host of new health-related bodies, such as patients' forums and independent complaints advocacy services in individual trusts. The government's aim is to bring patients' needs to the heart of NHS planning, giving them a say in the decision-making process through a system that provides effective scrutiny and democratic accountability.

There are dangers, however. "We need to make sure we don't add a tier of bureaucracy to the system - and we must make sure we don't step on each others' toes," warns David Munro, a councillor on Surrey's adults and community care committee. As to how health scrutiny will fit with other new bodies, he admits that "we don't have definitive answers" and sees "problems in training ourselves to be hard-hitting and insightful".

Surrey is currently looking at how to structure its scrutiny committee and plans to conduct a pilot inquiry this autumn into transport to hospitals.

Local authorities that are well into a programme of health scrutiny are, not surprisingly, those which have long-standing relationships with local health trusts - and those where higher levels of multiple deprivation have resulted in additional government funding for social care, health and other services in the locality. In some areas, such as Barking and Dagenham, east London, or Barnsley, in south Yorkshire, social services has already linked formally - budget and all - with its local primary care trusts (PCTs) to provide services jointly.

Such "joined-up" service delivery is the ultimate aim of health scrutiny, says Julia Ross, who serves as both Barking and Dagenham's director of social services and chief executive of the local PCT. She has also been appointed to health secretary Alan Milburn's modernisation board, overseeing progress of reforming the NHS. Along with strong partnerships, Ross wants to see overview and scrutiny committees making the role of public health a common element in all their inquiries.

Fiona Campbell, coordinator of the Democratic Health Network, a thinktank providing policy advice on the developing relationship between local government and health, agrees. "What local government can add is a strategic overview of delivery of health services to the community," she says. "It should not just be about looking at NHS services, but about how all other services like housing and leisure impact on the health of a community."

Many of those involved emphasise the need for scrutiny committees to be non-adversarial in their approach. "If we're constant critics, rather than critical friends, then we won't be listened to," says Andrew Brown, chair of the social care and health select committee of Lewisham council, south London.

But many authorities have some way to go before health scrutiny will do more than scratch the surface. "I don't think we have a clear vision yet in Worcestershire of what health scrutiny is, or how it will work," admits Howard Martin, a councillor on the working group looking at how to implement health scrutiny.

In the run-up to the last general election, the proposed abolition of acute services at Kidderminster hospital politicised health in Worcestershire more than anywhere else in the country. The Health Concern party, of which Martin is a member, has an MP, as well as seats on the county and district councils.

The party's leader, John Gordon, is adamant that health scrutiny should not make "puppets" out of councillors. He wants to make a success of the new powers, but he has worries. "It could take two years before we're seeing any results," he says. "If we're not careful, bureaucracy has a way of burying bad news - and that's something we have to make sure doesn't happen."

Power play

Local authorities may differ in their approach to health scrutiny, but on one thing they are agreed: the level of funding may make or break the effectiveness of the initiative.

"It's a whole new area of activity," says Sarah Pickup, assistant director of adult care services at Hertfordshire county council. "Certainly, in many areas, councillors have the scrutiny bit between their teeth. But if it's not funded properly, ultimately it's only a power - not a duty."

In other words, councils would be within their rights not to exercise that power. Indeed, some have been slow to get started with health scrutiny to make a political point, claims Fiona Campbell, of the Democratic Health Network. She says: "They're saying to government: 'How can you do this without putting some resources into it?'"

Over a year into health scrutiny in Barnsley, south Yorkshire, councillors want to improve their scrutiny programme. They want funding to bring in the specialised advice of a health expert, according to Len Picken, chair of Barnsley's social affairs and health scrutiny committee. He says: "Until now, we've not thought about the money - we've just got on with it."

Other councils, including Durham, point to the need to hire health experts at an early stage to offer training and guidance to councillors responsible for scrutinising health, as well as to officers supporting the function.

Just how much health scrutiny will cost councils is open to debate. Bedfordshire - which is now expert in the process of external scrutiny, having completed a select committee investigation of the riots and fire at Yarl's Wood detention centre earlier this year - estimates that health scrutiny will cost some £400,000 a year to be done properly.

"I don't think it can be grafted on and done for free," says Bedfordshire's assistant chief executive, Bill Hamilton, who also sits on the national committee advising the Department of Health on the modernisation transition. "The current position in Bedfordshire and Luton is if health scrutiny is not funded properly, we are not prepared to do it."

Alastair Henderson, policy manager of the NHS Confederation, which represents health bodies, is not anticipating additional funding from the Department of Health. Nor is he particularly sympathetic to claims that health scrutiny is a totally new function for councils, thereby warranting extra cash. "Of course, there are resource issues, but to say that health scrutiny is entirely different is not the case," he says. "A number of councils were already expanding their roles to have a health and social care function."

Health ministers are still finalising details of the spending review settlement - as well as the £23m that went into running the community health councils - and an announcement is expected shortly.